Friday, August 21, 2009

The Debate Over Seniors and Healthcare Reform: A Slew of Contradictions and Inaccuracies

The debate over healthcare for seniors has included numerous contradictions and inaccuracies. The topic became an unnecessary lightening rod after several conservative politicians falsely asserted that the pending House legislation would create "death panels" to determine whether the elderly could live or die. Although numerous commentators have discredited this idea, the issue of healthcare reform and seniors remains subject to distortion and contradictions.

Fear Surrounding MedicareMany seniors are also nervous because President Obama seeks to cut billions of dollars from Medicare over 10 years. These savings would theoretically help to offset the costs associated with broader healthcare reform, including the implementation of a public plan.

Although cuts to Medicare are a legitimate concern for seniors, the discussion of this issue has involved highly inaccurate portrayals of the proposed legislation. Furthermore, some conservatives (including seniors) have reacted to the proposed Medicare cuts in a way that contradicts their purported ideology.

"Illegal Aliens"Many conservative opponents of healthcare reform contend that Democrats are cutting Medicare benefits in order to finance the provision of healthcare to "illegal aliens." Every plan under consideration, however, excludes undocumented individuals from coverage. Nevertheless, people continue to raise this scarecrow argument as a basis for opposing reform.

Although sound arguments (and even Supreme Court precedent) could justify the provision of medical care to certain classes of undocumented individuals (like children), the proposed legislation does not provide such coverage. Federal law, however, already requires emergency rooms to treat everyone who seeks care, and many undocumented individuals receive medical services in emergency rooms. It would be unconscionable to deny care to individuals in an emergency setting. People can disagree with this assertion -- but this is already the status of the law; the proposed reforms have nothing to do with this issue.

Furthermore, in certain emergency situations, denying care to an undocumented person could result in a lack of treatment for a United States citizen. For example, an undocumented pregnant woman who arrives at an emergency room in labor needs medical care for herself and for her child. The child is a United States citizen even though the mother is not. Post-natal services could also benefit the undocumented mother and the citizen child. It might also be impossible to determine whether someone is undocumented or not before rendering care (e.g., a person incapacitated by a car accident, stroke, etc.). Finally, as a reader (Broadsnark) points out in the comments section, treating undocumented individuals can advance the health of the public (think: preventing the spread of contagious disease).

The Democrats/Obama Want to Cut Costs; Costs = ServicesMany conservatives argue that cutting Medicare costs will lead to the inevitable erosion of services. Conservative organizations and politicians have exploited this issue in an effort to alienate Democrats and seniors, who are faithful voters who tend to favor Democrats. Although this strategy might generate some benefits for Republicans, the conservative portrayal of Democrats as the enemies of Medicare is awfully hypocritical and dishonest for several reasons.

First, every major presidential candidate who promised to reform the healthcare system also discussed cutting Medicare costs. In October 2008, the Wall Street Journal reported that John McCain intended to finance his healthcare plan (which would have provided tax credits to purchase insurance) by slashing expenditures associated with Medicare and Medicaid. Douglas Holtz-Eakin, McCain's senior policy adviser, argued that McCain's plan would cut costs without compromising care: "It's about giving them the benefit package that has been promised to them by law at lower cost. . . ." Independent analysis estimated that McCain's plan would have stripped over $1 trillion from Medicare and Medicaid.

The following footage from an April 2008 townhall meeting in Allentown, Pennsylvania shows McCain making the case for reducing Medicare expenditures, while maintaining the quality of care.

(Article continues below the video)

Even Mike Huckabee -- the most conservative of the Republican contenders -- advanced cost-reduction as a method of reforming the healthcare system. Although Huckabee never created a detailed reform package, as governor of Arkansas and as a presidential candidate, he emphasized prevention of illness as a way to cut costs and to make healthcare affordable.

The "erratic" Mitt Romney also endorsed Medicare expenditure cuts. While he was Governor of Massachusetts, Romney presided over the implementation of universal healthcare in state. Nevertheless, during his presidential campaign, he repeatedly emphasized the need to cut costs of entitlement programs, including Social Security, Medicare and Medicaid.

Despite the bipartisan support for cutting Medicare costs, many seniors now accuse Democrats of attempting to compromise their well being. Some of these individuals have apparently sought solace in conservative membership organizations. But conservatives -- not liberals -- have been very hostile to Medicare (see below).

Conservatives Oppose "Public Plans," Including MedicareConservatives who portray Democrats as the enemies of Medicare are acting in a shamefully hypocritical fashion. Conservatives have a long history of opposing and criticizing Medicare. In the 1960s Ronald Reagan gave his voice to "Operation Coffeecup," a political movement organized by the AMA to block the passage of Medicare. Reagan and other conservatives described the proposed legislation as "socialized medicine" and argued that it was a step towards totalitarianism. In an October 2008 speech, Sarah Palin approvinglyquoted Reagan's statements regarding the oppressive nature of Medicare.

Medicare is the largest public health plan in the nation. Conservatives have a long history of describing public plans as socialized medicine. Using the frightening (but empty) rhetoric of socialized medicine, conservatives attacked Medicare, the failed Clinton reforms in 1992, the State Children's Health Insurance Program (Bush vetoed additional funds for this program two times), and the current proposal for a public plan option.

Accordingly, conservatives who portray liberals as a threat to seniors, who rely almost exclusively upon Medicare for their healthcare needs, are engaging in utter hypocrisy. Seniors who benefit from Medicare, but who accept the conservative rhetoric of "socialized medicine," are also behaving like hypocrites.

Final ThoughtsI am interesting in hearing more about Obama's proposal to cut costs related to Medicare. Part of the reduction would come from lower drug costs, and he has already negotiated a deal with pharmaceutical companies. Undoubtedly, many of the cuts would result from a reform in the way the government compensates Medicare providers, and it could include raising premiums on wealthier seniors.

Although cutting costs does not translate necessarily into a compromise in the quality of healthcare, it might result in a different mix of available services. But this should not defeat the plan. Medicare already covers and denies coverage for certain services. Private insurance companies do so as well -- and the notion that individuals can negotiate around this is gross distortion. Try going on the "open market" and getting coverage for a pre-existing condition.

I am interested in having an honest discussion regarding Medicare and cost reductions. Unfortunately, fearmongering keeps getting in the way.

UPDATE: I neglected to mention that during the presidential campaign, Obama equated McCain's proposed cuts in Medicare expenses with cuts in services. So, he on some level, he is receiving the same criticism that he offered McCain. FactCheck.Org has written on this subject.

2 comments:

The whole "illegal aliens" thing drives me crazy on so many levels, but I am seriously amazed by the short sightedness of these people. Even if you are a cold-hearted, anti-immigrant, hateful xenophobe who thinks undocumented immigrants should just die when they get sick; you still have to be in favor of health care. Viruses don't really care whether or not you are legal. If people don't have access to health care, it is public health issue for all of us. Seriously, hatred makes people brain dead.

About Me and the Blog

Professor Darren Hutchinson teaches Constitutional Law, Remedies, Race and the Law, and a Civil Rights Seminar at the University of Florida Levin College of Law. Professor Hutchinson also holds the prestigious Stephen C. O’Connell Chair.
Professor Hutchinson received a B.A. from the University of Pennsylvania and a J.D. from Yale Law School. Before teaching law, Professor Hutchinson practiced commercial litigation at Cleary, Gottlieb, Steen and Hamilton in New York City. He also clerked for the late Honorable Mary Johnson Lowe, a former United States District Judge in the Southern District of New York.
Professor Hutchinson's research has appeared in many prestigious journals including the Cornell Law Review, Washington University Law Review, UCLA Law Review, University of Michigan Journal of Race and Law, and University of Pennsylvania Journal of Constitutional Law.
He has also presented his research at numerous universities, including Yale, Stanford, Columbia, University of Pennsylvania, University of Michigan, University of California at Berkeley, University of Virginia, Cornell, Georgetown, and Boston University.

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